Modified Adjusted Gross Income (MAGI) Medical

Created on: 
Nov 06 2019

Online Processing

See ACES Screens and Online pages for an example of pages or screens used in this chapter.

What is Modified Adjusted Gross Income (MAGI)?

MAGI is a methodology used to determine household composition and calculate the countable income when determining eligibility for Medicaid or Children's Health Insurance Premium (CHIP) medical.

The MAGI income methodology is based on the Internal Revenue Service (IRS) tax filing status of the applicant.

What is Modified Adjusted Gross Income (MAGI) based medical?

MAGI-based medical refers to Medicaid and Children's Health Insurance Premium (CHIP) coverage for individuals who are relatable to Medicaid/CHIP if they are:

  • A child under age of 19,
  • Pregnant,
  • A custodial parent/caretaker, or
  • An eligible adult between ages 19 and 65 whose income is below the Federal Poverty Level (FPL) threshold for the program using the MAGI income methodology.

How do clients apply for Modified Adjusted Gross Income (MAGI) medical?

Individuals apply for MAGI medical through the Health Benefit Exchange called Washington Healthplanfinder. Washington Healthplanfinder is an online portal that processes MAGI medical applications.

Who is responsible for Modified Adjusted Gross Income (MAGI) medical Assistance Units (AUs)?

MAGI medical AUs belong to the Health Care Authority (HCA) and are processed in the Washington Healthplanfinder system. They are assigned to the following HCA Community Service Offices (CSOs):

  • 181 - MAGI AUs that belong to Region 1 geographical/zip catchment
  • 182 - MAGI AUs that belong to Region 2 geographical/zip catchment
  • 183 - MAGI AUs that belong to Region 3 geographical/zip catchment

ACES users are not be able to screen, initiate a review, add a person, reopen or reinstate MAGI AUs.

Any user with inquiry access in ACES or ACES.online is able to see limited data pertaining to MAGI AUs in ACES Mainframe and in ACES.online.  

What are the Modified Adjusted Gross Income (MAGI) medical groups?

The following is a list of the MAGI medical groups:

What happens when changes are reported in Washington Healthplanfinder?

When changes are reported by an individual in Washington Healthplanfinder for a Modified Adjusted Gross Income (MAGI) Assistance Unit (AU), and there is a related Cash, Classic Medicaid, or Basic Food AU in ACES, the system takes the appropriate action on the related AU which could include:

  • Overlaying some of the ACES data with the Healthplanfinder data.
  • Displaying some of the MAGI data in ACES.online for comparison against existing ACES data.
  • Generating a Barcode Tickle.
  • Invoking a call to the Eligibility Service for a benefit recalculation.
NOTE: When an address change is made in ACES to a Cash, Basic Food or Classic Medical AU and there is a related MAGI AU, the change is communicated back to Washington Healthplanfinder by a manual process. Reports are generated for Health Care Authority users to manually make demographic changes in their system to keep data in sync between the two systems.

Can a client receive Modified Adjusted Gross Income (MAGI) medical coverage while incarcerated?

When a client is active or approved under some medical coverage groups while incarcerated, they can still be eligible to receive medical assistance in a suspended status. For more information, see Suspended Medical – State Bill (SB 6430).

Online Processing

Who can invalidate Continuous Eligibility Tracking (CTCN) for Modified Adjusted Gross Income (MAGI) Assistance Units (AUs)?

Only workers assigned to CSO 076 (MEDS) with the secured task of A 2 can invalidate CTCN for MAGI AUs.

How do I invalidate Continuous Eligibility Tracking (CTCN) for Children's Washington Apple Health (WAH) Modified Adjusted Gross Income (MAGI) in ACES.online?

When it has been discovered that the CTCN period for Children's WAH has been opened in error take the following steps:

  1. From the client's Summary page, select Children's Tracking CN Medicaid from the Details drop down menu.
  2. On the Children’s Tracking CN Medicaid page, click Cancel next to the CTCN period to be invalidated. The following message displays "You are about to end continuous eligibility tracking. This action cannot be undone. Click "OK" to end the tracking or click "Cancel" to return to the previous page."
Note:  Invalidating CTCN tracking cannot be undone.
  1. Click OK to invalidate the selected CTCN period for the client.

Workers must go back into Healthplanfinder to invoke an eligibility call to the Eligibility Service.

How do I invalidate Modified Adjusted Gross Income (MAGI) N01 (Parent/Caretaker) or N02 (Transitional Medical Coverage (TMA)) in ACES.online?

When it has been discovered that an individual was opened on a N01 or N02 Assistance Unit (AU) in error for a particular month take the following steps:

  1. From the Assistance Unit's (AU) Summary page, select Demographics from the Details drop down menu.
  2. On the Demographics page, click the checkbox next to Exclude from N01/N02 Determination in the Details section.

The page refreshes and displays the updated checkbox and the medical coverage group is invalidated for the given month.

Note: This field is only visible for AUs that are Active, Historically Closed or Closed with a paid thru date greater than or equal to the current benefit month.

If it is discovered the invalidation was done in error workers can go back to the AU's Demographics page and remove the checkmark next to the Exclude from N01/N02 Determination for any given month.

Workers must go back into Healthplanfinder to invoke an eligibility call to the Eligibility Service.

How do I flag an individual to identify that they have incorrectly attested to their income, citizenship or immigration status?

When an individual has been found to have incorrectly attested to their income, citizenship or immigration status, workers with Unit Type 76 can update the Prevent WAH/MAGI Approval flag in ACES.online by taking the following steps:

  1.  On the Welcome back page, complete the following fields in the Quick Navigation section: 

  • Select a Type of ID drop down box - Select Client.
  • Enter an ID field - Enter the [Client ID number].
  • Select a Page drop down box - Select Demographics.
  • Click the Go button and the Summary page displays.
  1. Select the Yes radio button in the Prevent WAH/MAGI Approval field.
Note: Once the Yes radio button is submitted, the Last Updated field displays the date of the last action and the User ID of who completed it.

 

See ACES Screens and Online pages for an example of pages or screens used in this chapter.